Being an Austrian mother with rheumatoid arthritis

233 Pages·2017·5.8 MB·English

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Birgit Prodinger, The University of Western Ontario
Supervisor: Lynn Shaw, PhD, The University of Western Ontario
A thesis submitted in partial fulfillment of the requirements for the Doctor of Philosophy degree
in Health and Rehabilitation Sciences
© Birgit Prodinger 2012
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Prodinger, Birgit, "Being an Austrian mother with rheumatoid arthritis: An institutional ethnography about
the social organization of everyday life" (2012). Electronic Thesis and Dissertation Repository. 596.
https://ir.lib.uwo.ca/etd/596
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Being an Austrian mother with rheumatoid arthritis:
An institutional ethnography about the social organization of everyday life.

(Spine title: Everyday life of Austrian mothers with rheumatoid arthritis)

(Thesis format: Monograph)

by

Birgit Prodinger

Graduate Program in Health and Rehabilitation Sciences

A thesis submitted in partial fulfillment
of the requirements for the degree of
Doctor of Philosophy

The School of Graduate and Postdoctoral Studies
The University of Western Ontario
London, Ontario, Canada

© Birgit Prodinger 2012
THE UNIVERSITY OF WESTERN ONTARIO
School of Graduate and Postdoctoral Studies

CERTIFICATE OF EXAMINATION

Supervisor Examiners

______________________________
Dr. Lynn Shaw ______________________________
Dr. Elizabeth Francis-Connolly

Supervisory Committee _____________________________
Dr. Pamela McKenzie
______________________________
Dr. Carol Agocs
______________________________

Dr. Lilian Magalhães
______________________________

Dr. Debbie Laliberte Rudman
______________________________

Dr. Tanja Stamm
______________________________
Dr. Tanja Stamm

The thesis by

Birgit Prodinger

entitled:

Being an Austrian mother with rheumatoid arthritis: An
institutional ethnography about the social organization of
everyday life.

is accepted in partial fulfillment of the
requirements for the degree of
Doctor of Philosophy

______________________ _______________________________
Date Chair of the Thesis Examination Board

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Abstract

This institutional ethnography research explored how women with rheumatoid arthritis,
who are mothers, and of employable age, go about their daily lives given their social
context. The social context for this research was Austria, which is characterized by social
policies based on familialism and an emphasis on employment. This context may open up
various resources and possibilities about what women can do and actually do in their
daily lives, and thus, directs attention to the situated nature of human occupation.
In institutional ethnography particular attention is given to the social, which suggests that
daily life becomes accomplished through coordinated activities of various individuals
who are active across places and time. These social relations often remain invisible.
Institutional ethnography aims to explicate these social relations by exploring the work,
that is, anything that requires time, effort, and has intent, of individuals in their daily
lives. An understanding of the work of the seven women in going about their lives was
collected by means of interviews and participant observations. Texts were analyzed to
understand how the actual, local doings of the women are coordinated to trans-local
relations. Texts have a mediating character and coordinate the women’s consciousness
into relations ruling organizational processes.
The findings contain a thick description of the women’s actual work in their daily lives;
an explication of how their doings are coordinated to the relations ruling arthritis-related
health care; and relations organizing processes related to employment and invalidity.
What the women do, how they do it, and with whom, depends on how they are situated
within social relations. Once they enter arthritis-related health care, their experiences
become coordinated to medical concepts ruling these particular relations; once the
women enter relations at the labor market, the concept of employability rules the
processes there. Within these respective ruling relations, the complexity of the women’s
daily lives is not accounted for.

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This research illustrates the necessity for attending to the situated nature of how
individuals go about their daily lives to comprehensively understand the social
organization and work that goes into accomplishing the ordinary activities of everyday
life.

Keywords
Institutional ethnography, rheumatoid arthritis, Austria, women, occupation,
employment, familialism, occupational science, ruling relations, health care;

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Acknowledgments
This dissertation was only possible due to the support and encouragement of many
people. I cannot do justice to acknowledge all personally here, but I would like to express
some special acknowledgements:
I express my sincere gratitude to my supervisory committee: Drs Lynn Shaw, Carol
Agocs, Debbie Laliberte Rudman, and Tanja Stamm. Thank you for numerous rich and
enriching discussions, your thorough, thoughtful, and critical feedback throughout this
journey, and for fostering my personal and academic growth.
I extend special thanks to my examining committee Drs Elizabeth Francis-Connolly,
Pamela McKenzie, Lilian Magalhães, Tanja Stamm for their generous and inspiring
feedback. I am humbled by your confidence in my work.
I acknowledge the support of faculty and staff from the Graduate Program in Health and
Rehabilitation Sciences, Field of Occupational Science, at The University of Western
Ontario, Canada, as well as from staff of the Department of Rheumatology, Medical
University of Vienna, Austria.
I highly value my discussions with institutional ethnographers who I was able to meet
along the way – I would like to extend my appreciation in particular to Dr. Susan Marie
Turner and Dr. Elizabeth Townsend.
The past years have been travel intense: I thank family and friends who gave me
numerous rides to and from the airport or train-stations, hosted me whenever and
wherever needed, and made any transition much more pleasant.
I am grateful for the support of my closest friends: thank you for letting me have a share
in your lives too!
I would like to extent my appreciation to my dear family: I acknowledge in particular the
unconditional love and trust of my parents: thank you for your patience and
understanding throughout various ups and downs, for providing me with roots, that is, a
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caring home and a sense of belonging, as well as with wings that provided me the
confidence and freedom to explore various paths in life. I also want to acknowledge the
support of my brother Michael: thank you for always maintaining a clear mind about any
practical and organizational things even when my vision was blurred, for remembering
me that one step at a time is enough, and for being always within reach!
My research would not have been possible without the commitment of the women who
participated in this research – I offer my sincere thanks to these seven women.

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Table of Contents
CERTIFICATE OF EXAMINATION ............................................................................... ii
Abstract .............................................................................................................................. iii
Acknowledgments............................................................................................................... v
Table of Contents .............................................................................................................. vii
List of Tables ..................................................................................................................... xi
List of Figures ................................................................................................................... xii
List of Appendices ........................................................................................................... xiii
List of Abbreviations ....................................................................................................... xiv
Glossary ........................................................................................................................... xvi
Chapter 1 ............................................................................................................................. 1
1 Introduction .................................................................................................................... 1
1.1 The structure of this dissertation ............................................................................. 3
1.2 The Austrian context ............................................................................................... 6
1.2.1 The Austrian health care system ................................................................. 6
1.2.2 The Austrian social welfare system .......................................................... 10
1.3 Situating the daily life of women within the Austrian system .............................. 19
1.4 Situating this dissertation in occupational science................................................ 22
Chapter 2 ........................................................................................................................... 28
2 Daily life of women with rheumatoid arthritis ............................................................. 28
2.1 The medical condition of rheumatoid arthritis...................................................... 28
2.2 The complexity of the daily life of women with rheumatoid arthritis .................. 31

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2.3 Women with rheumatoid arthritis and arthritis-related health care ...................... 39
2.4 The reduction of the complexity of daily life into individualized accounts ......... 42
Chapter 3 ........................................................................................................................... 45
3 Going beyond the individual – attending to the social ................................................ 45
3.1 A social perspective on rheumatoid arthritis ........................................................ 46
3.2 Social perspectives on managing daily life with rheumatoid arthritis .................. 49
3.3 The need for research about the situated nature of how Austrian women with
rheumatoid arthritis go about their daily lives ...................................................... 54
Chapter 4 ........................................................................................................................... 57
4 Institutional ethnography: A conceptual framework for inquiry ................................. 57
4.1 Starting with women’s experiences ...................................................................... 57
4.1.1 The standpoint of women.......................................................................... 58
4.1.2 The ontology of the social......................................................................... 59
4.2 Social relations ...................................................................................................... 61
4.2.1 Ruling relations ......................................................................................... 64
4.2.2 Language and discourse ............................................................................ 65
4.2.3 Agency and subjectivity ............................................................................ 67
4.3 Studying what individuals do in daily life ............................................................ 68
4.4 Translating the conceptual framework into research: The work of Austrian
mothers with rheumatoid arthritis ......................................................................... 70
4.4.1 The problematic guiding this institutional ethnography ........................... 71
4.4.2 Research relations ..................................................................................... 73
4.4.3 Informants ................................................................................................. 77
4.4.4 Data collection .......................................................................................... 79
4.4.5 Analytical description ............................................................................... 85

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4.4.6 Ethical considerations ............................................................................... 87
4.4.7 Rigor in institutional ethnography ............................................................ 89
4.4.8 Presentation of analytical descriptions ...................................................... 91
Chapter 5 ........................................................................................................................... 92
5 Ethnographic accounts of the women’s daily life ........................................................ 92
5.1 Getting the work of daily life done ....................................................................... 92
5.1.1 Getting started in the morning .................................................................. 93
5.1.2 Arranging one’s place ............................................................................... 95
5.1.3 Preparing food for the family .................................................................... 96
5.1.4 Using transportation .................................................................................. 98
5.2 Being a mother .................................................................................................... 100
5.3 Being cared for .................................................................................................... 103
5.4 Sustaining well-being.......................................................................................... 105
5.5 Discussion ........................................................................................................... 107
Chapter 6 ......................................................................................................................... 110
6 The ruling power of arthritis-related health care ........................................................ 110
6.1 The work setting of arthritis-related health care ................................................. 110
6.2 The organization of the production of hospital records ...................................... 113
6.3 The ruling of the women’s work in the setting ................................................... 121
6.3.1 Authoritative knowledge ......................................................................... 124
6.3.2 Complementary treatment ....................................................................... 128
6.3.3 The textual production of the informed patient ...................................... 130
6.4 Discussion ........................................................................................................... 137

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